Critics: Study Faulting Dialysis Centers Is Flawed

People treated at for-profit kidney dialysis centers have higher death rates than those treated at nonprofit centers, but critics say the investigation reporting the difference is flawed.

The analysis by New York and Canadian medical scientists reviewed eight studies conducted from the early 1970s through 1997. An excess 2,500 deaths per year was found among people who underwent hemodialysis in the for-profit centers. That amounts to an 8 percent higher rate of death in centers controlled by groups of investors.

Medicare pays the cost of hemodialysis, a process that passes a patient's blood through filters to remove toxins. Nearly 400,000 people in the United States whose kidneys have failed are on dialysis.

More than 500,000 people were treated at for-profit and nonprofit centers during the years of the analysis in 1,342 centers.

Researchers at the University of Buffalo and McMaster University in Ontario say the results show medical care can become lethal when economics are at issue.

"The math worked this way," said Dr. Gordon Guyatt, one of the researchers and a professor of medicine at McMaster University. "In a situation where you'd find 100 deaths in a non-profit center, there would be 108 in the for-profit."

Guyatt and colleagues, reporting in today's Journal of the American Medial Association, blamed shortcuts in care.

But critics have lambasted the study. Dr. David Warnock, president-elect of the National Kidney Foundation, said the analysis is out of date.

"There is no reason to doubt the validity of these findings [as being] relevant to that time period, but I am very uncomfortable applying these results to 2002," he said.

During the years of the study, dozens of for-profit centers were in business, Warnock said. Since then, hemodialysis centers have undergone consolidation, with only four for-profit chains remaining.

"There is also a non-profit chain," Warnock said, "which is not appreciably different than the others. Many of the distinctions described in the [study] have been blurred."

But Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, a consumer watchdog group in Washington, D.C., said the analysis uncovered the same volatile issue he has found: For-profit health centers equate with a lower quality of care.

"The capacity exists to impose much more control over the quality" of dialysis treatment at for-profit centers, Wolfe said. Opponents of for-profit care say Medicare could withhold payments when quality care is not delivered.

Guyatt and his colleagues charge that the for-profits generate more cash by hiring less-qualified staff and by reducing the time people are on dialysis.

Warnock thinks kidney patients have options. "They can certainly ask to see the specific outcome indicators for their individual dialysis unit: how does their unit compare to local, regional and national norms," he said.